Smith Jonathan M C, Andrade Jason G, Human Derek, Field Thalia S
M.D. Senior Pediatric Neurology Resident, University of British Columbia, Vancouver, BC, Canada.
FRCPC Clinical Associate Professor of Cardiology, University of British Columbia, Vancouver, BC, Canada.
Front Neurol. 2019 Apr 4;10:329. doi: 10.3389/fneur.2019.00329. eCollection 2019.
As infant and childhood mortality has decreased in congenital heart disease, this population is increasingly reaching adulthood. Adults with congenital heart disease (ACHD) represent a group with increased risk of stroke, silent brain infarcts, and vascular cognitive impairment. Cyanotic and other complex cardiac lesions confer the greatest risk of these cerebrovascular insults. ACHD patients, in addition to having an increased risk of stroke from structural cardiac issues and associated physiological changes, may have an accelerated burden of conventional vascular risk factors, including hypertension and impaired glucose metabolism. Adult neurologists should be aware of the risks of clinically evident and subclinical cerebrovascular disease in this population. We review the existing evidence on primary and secondary stroke prevention in individuals with complex congenital heart disease, and identify knowledge gaps in need of further research, including treatment of acute stroke in this population. Multisystemic genetic syndromes are outside the scope of this review.
随着先天性心脏病患儿及儿童死亡率的下降，这一群体正日益步入成年期。患有先天性心脏病的成年人（ACHD）是中风、无症状脑梗死和血管性认知障碍风险增加的群体。青紫型及其他复杂心脏病变会带来这些脑血管损伤的最大风险。ACHD患者除了因心脏结构问题及相关生理变化而有更高的中风风险外，还可能有传统血管危险因素（包括高血压和糖代谢受损）负担加重的情况。成人神经科医生应意识到这一群体中临床明显和亚临床脑血管疾病的风险。我们回顾了关于复杂先天性心脏病患者一级和二级中风预防的现有证据，并确定了需要进一步研究的知识空白，包括该群体急性中风的治疗。多系统遗传综合征不在本综述范围内。
